TBI Specialist Seeks to Customize Treatment for Brain-Injured Veterans

By Steve Spotswood

Joel Scholten, MD

WASHINGTON — For the past eight years, Joel Scholten, MD, has enjoyed both a ground-level, exam-room view of traumatic brain injury (TBI) care in VA, as well as a bird’s-eye view of national policy, and both perspectives reveal the same thing: There are as many appropriate treatment plans for TBI as there are veterans suffering from the injury.

“Each treatment plan is highly individualized, depending on the veteran and their unique injuries or issues, as well as their degree of family and social support,” explained Scholten, who provides clinical care at the DC VAMC as its associate chief of rehab services, as well as serving as national director of special projects with the VA’s Physical Medicine and Rehabilitation Program Office. “We have to course correct frequently. We review most treatment plans every three months or so, sometimes more frequently, if they’re having more-severe symptoms.”

While TBI patients might start out on a similar treatment plan, by the time they get to the end of the course, each veteran will have taken a treatment path as individual as a fingerprint. According to Scholten, this is inevitable with an injury that is so deeply entwined with other comorbid conditions, the treatment for which is so dependent on a patient’s lifestyle and social resources.

TBI patients in VA usually start in one of two places. The first is entering the system post-trauma. The other is through VA’s screening program. Any veteran separating from DoD is screened for a possible TBI, as well as during their first primary care visit to VA. Whether it’s immediately post-trauma or later, the veteran is then evaluated by a TBI specialist. During that evaluation, they’re provided with a diagnosis, and a treatment plan begins to develop.

“The plan incorporates their specific symptoms, as well as the patient’s needs and goals,” Scholten explained. “We not only provide specific therapies to maximize their independence but also try to accommodate their work schedules, because many are still working, and the goal is not for them to be a professional patient. We want them to be a functioning and successful member of the community.”

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